Please see below an email reply to my question posed to a MD in USA. Rising TSH, low FT4 and high FT3.
Personally this doesn't help me as I'm still being told that as I'm creating enough of my own FT3 there is no need for T4 supplementation. However, this reply implies that low FT4 is low FT4 however you look at it. I know also that RT3 is not an issue so I should be ruddy wonderful!
How are we ever to get to the bottom of this when there is so much disagreement?
When is T4 supplementation needed?
Where TSH is steadily rising now at 2.8 and Free T4 is always low around 12 (range 10 - 24) but Free T3 is high 6.9 (range 0.5 - 5.7) would this still indicate the need to T4 supplementation? If conversion is doing so well what would be the point? This is in conjunction with SIBO, hair-loss, fatigue etc but with gluten,dairy and sugar free diet already in place. No antibodies, adrenals, vit d, ferritin and B12 all ok. Your thoughts would be most appreciated.
In this setting in my patients, the first question is are they taking any T3 containing products. If yes, then the test is meaningless and I would likely increase the thyroid dose if symptoms overall are suggestive in any case. If on no T3, I would check a reverse T3 level and if high, suggests that T3 is the preferred form of thyroid. If not, Armour thyroid.